1 - Unidade de Adolescentes, Hospital Dona Estefânia, Unidade Local de Saúde de São José
- 10th Congress of the European Academy of Pediatric Societies 2024, poster
Resumo:
Background and Aims: A 16-year-old female adolescent presented to the emergency department with significant weight loss (32% of body weight) and peripheral edema, in the context of distorted body image, reduced food intake, increased exercise and amenorrhea. In the two weeks prior, due to muscle weakness and easy fatigue, she had attempted to increase her food intake.
Methods: The examination revealed severe malnutrition with a BMI of 12 kg/m², significant muscle weakness (eg.: unable to comb her hair or rise without assistance), as well as typical signs of anorexia nervosa including sinus bradycardia (38 bpm), postural tachycardia, orthostatic hypotension, and hypothermia. Analytical evaluation highlighted anemia, thrombocytopenia, leukopenia, hypophosphatemia (2.2mg/dL), hypoglycemia, acute renal injury, and elevated transaminases. Upon hospitalization, she received a cautious nutritional regimen alongside phosphate, thiamine, and multivitamin supplementation. The initial week of hospitalization was particularly challenging, marked by persistent bladder and bowel incontinence, a direct result of perineal muscle wastage. Anorectal manometry and evaluation by the Urology team revealed no abnormalities.
Results: Sphincter incontinence was resolved following 36 days of hospitalization with a BMI of 12.8 Kg/m2. After 44 days, presenting with a BMI of 13.3 Kg/m2, she was transferred for specialized psychiatric care.
Conclusions: This case highlights the critical impact of anorexia nervosa on muscle deterioration, leading to significant bladder and bowel incontinence. It underscores the necessity for a carefully monitored nutritional rehabilitation to mitigate refeeding syndrome risks in severely malnourished individuals, within a multidisciplinary treatment framework that addresses the complex facets of the disorder.
Palavras Chave: adolescent, anorexia nervosa, bladder incontinence, bowel incontinence